Healthcare Provider Details

I. General information

NPI: 1053307124
Provider Name (Legal Business Name): JOSEPH LEONCE CHARLOT JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 11/30/2023
Certification Date: 04/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 TAYLOR RD STE 23321
CHESAPEAKE VA
23321-2246
US

IV. Provider business mailing address

2613 TAYLOR RD STE 101
CHESAPEAKE VA
23321-2246
US

V. Phone/Fax

Practice location:
  • Phone: 757-465-4000
  • Fax:
Mailing address:
  • Phone: 757-465-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number042247
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number25MA07041600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number042247
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101057818
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number0101057818
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: